Regenerative endodontic procedures for the treatment of necrotic mature teeth: A preliminary randomized clinical trial

Abstract

Aim: This preliminary randomized, prospective, controlled trial aimed to compare the clinical and radiographic outcomes of two regenerative endodontic procedures (REPs), revitalization and a platelet-rich fibrin (PRF)-based technique, in the treatment of mature permanent teeth with necrotic pulps. Methodology:The trial has been reported according to the Preferred Reporting Items for Randomized Trials in Endodontics 2020 guidelines. The study protocol was registered at the clinical trial registry (Clini calTr ials.gov) with identifier number NCT04158232. Twenty patients with mature necrotic anterior teeth with large periapical lesions were randomly allocated into two groups (n = 10): group I, treated with revitalization with the blood clot (BC) technique and group II, treated with a PRF-based technique. The follow-up was for 12 months. Periradicular healing was assessed using standardized radiographs taken at baseline, and at 6 and 12 months after treatment. An electric pulp tester was used to assess whether pulp sensibility had been regained during the follow-up period. Statistical analysis was conducted using Mann-Whitney test and Wilcoxon test for non-parametric data. For parametric data, repeated measures analysis of variance was used. The significance level was set at p ≤ .05.Results: There was a significant increase in periradicular healing in both groups at 6 and 12 months, compared to that at baseline, with no significant difference between the studied groups after 12 months (p = .143). There was a significant difference between the tooth sensibility readings at baseline, 6-month and 12-month follow-up timepoints (p < .001). Conclusions:The findings of this preliminary trial indicate the potential for using REPs, such as revitalization or PRF-based techniques, as treatment options for mature teeth with necrotic pulps. A higher level of evidence obtained through adequately powered clinical trials and longer follow-up periods are required to conclusively validate the different outcomes of REPs.

Evaluation of postoperative pain and healing following regenerative endodontics using platelet‐rich plasma versus conventional endodontic treatment in necrotic mature mandibular molars with chronic periapical periodontitis. A randomized clinical trial

“…Regarding the radiographic healing, preoperative and follow‐up records after 6 and 12 months showed a significant decrease in the periapical lesion size in both groups, these results are in agreement with El‐Kateb et al (2020) and Youssef et al (2022). Alagl et al (2017), Jadhav et al (2012), and Shivashankar et al (2017) showed that PRP revascularization was better than blood clot and PRF concerning periapical healing.…”

Comparative outcomes of platelet concentrates and blood clot scaffolds for regenerative endodontic procedures: A systematic review of randomized controlled clinical trials

“…15 Full – text articles were assessed for eligibility. After full article screening, 5 references were excluded with reasons ( 12 - 16 ) ( Table 1 ). Finally, ten randomized controlled clinical trials met the inclusion criteria for qualitative synthesis ( 6 , 17 - 25 ) (Fig.…”

Platelet-rich fibrin as an autologous biomaterial for bone regeneration: mechanisms, applications, optimization

“…PRF contains autologous high-density fibrin clots that act as a biological scaffold to support cell proliferation and migration; it also allows an increase in the concentration of local growth factors, stimulates regeneration of diseased pulp tissue, and promotes the formation of dentin and periapical bone tissue. Ahmed Youssef et al applied PRF to treat adult permanent anterior teeth with pulpal necrosis, and they showed significant improvement in pulp vitality and significant healing of periapical bone tissue at 6-month and 12-month postoperative follow-ups ( Youssef et al, 2022 ). In addition, Le Fort I osteotomy is most commonly used to correct osseous Class III maxillary deformities, and the critical factor for its success is the long-term stability of the bone block.…”